Provider Demographics
NPI:1831181171
Name:AL-JAYOUSSI, RANDA N (MD)
Entity type:Individual
Prefix:DR
First Name:RANDA
Middle Name:N
Last Name:AL-JAYOUSSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1249 15TH ST
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3662
Mailing Address - Country:US
Mailing Address - Phone:340-691-1000
Mailing Address - Fax:340-691-1693
Practice Address - Street 1:1249 15TH ST
Practice Address - Street 2:SUITE 3000
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3662
Practice Address - Country:US
Practice Address - Phone:304-691-1000
Practice Address - Fax:304-691-1693
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24071207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11963Medicaid
ND22176Medicare ID - Type Unspecified
NDH64094Medicare UPIN